Steep Price Hikes Led to Drop in Use of 2 Heart Drugs at U.S. Hospitals

Half as many patients got nitroprusside, while isoproterenol use fell one-third, study finds

-- Robert Preidt

WEDNESDAY, Aug. 9, 2017 (HealthDay News) -- After steep price hikes, use of two common heart medications declined significantly in U.S. hospitals, a new study shows.

The drugs, nitroprusside (Nitropress) and isoproterenol (Isuprel), have been used for decades.

The findings disprove claims that price increases do not reduce patient access to and use of certain medications, the Cleveland Clinic researchers said.

"In public testimony, it had been stated that these price increases would not decrease patient access or utilization of these two critical drugs, both of which have been used for decades in patient care," said lead author Dr. Umesh Khot, vice chairman of cardiovascular medicine.

"However, our research shows that these price hikes are not benign. Further research will determine if there has been any effect on patient outcomes, but it's clear that utilization has been impacted," Khot said in a clinic news release.

From 2012 to 2015, the price of isoproterenol in the United States increased nearly 70-fold -- from $26 to $1,790.

The research team looked at the drugs' use in 47 hospitals. The researchers found the number of patients treated with isoproterenol dropped 35 percent.

The cost of nitroprusside, meanwhile, rose 30-fold, from $27 to $880. And the number of patients treated with the drug fell 53 percent, the researchers said.

Because the two drugs are only used in hospitals, there is no external patient demand for them and no direct-to-consumer advertising, the researchers pointed out.

The researchers also looked at use of nitroglycerin and dobutamine, intravenous heart drugs with stable pricing. During the study period, the number of patients treated with nitroglycerin rose 118 percent, and dobutamine usage increased 7 percent.

Nitroprusside lowers blood pressure and is used to treat critical high blood pressure and congestive heart failure. Doctors also order it to keep blood pressure low during surgery.

Isoproterenol is used to treat low heart rate and heart block (when the heart beats too slowly). It's also used during electrophysiology procedures and certain types of surgery to increase heart rate, the researchers said.

"These are medications that physicians are very familiar with, and for which there are no direct alternatives. As a result, hospitals have had to reevaluate use of these drugs and potentially bring in other therapies," said Michael Militello, a doctor of pharmacy.

"Understanding how physicians, pharmacists and health systems have addressed their use of these medications is an important area of further study," he added.

The study appears as a letter to the editor in the Aug. 10 issue of the New England Journal of Medicine.